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Related Articles Comparison of Peak-Expiratory Flow Variability Between Workers with Work-Exacerbated Asthma and Occupational Asthma. Chest. 2007 May 15; Authors: Chiry S, Cartier A, Malo JL, Tarlo SM, Lemière C Background Peak-expiratory flow (PEF) monitoring is frequently used to diagnose occupational asthma (OA). The variability of PEF between periods at and away from work has not been described in workers with work-exacerbated asthma (WEA).We sought to assess and compare the diurnal variability of PEF during periods at and away from work between subjects with OA and WEA. Methods Workers referred for work-related asthma underwent PEF monitoring for 2 weeks at and away from work. The diagnostic of OA or WEA was subsequently made according to the respective positivity or negativity of the specific-inhalation challenges. The PEF's mean diurnal variability was calculated during periods at and away from work. PEF graphs were also interpreted using direct visual analysis by five observers and by using the Oasys-2 expert system. Results Thirty-four subjects were investigated (WEA: 15; OA: 19). There was a greater variability of PEF at work than away from work in both OA (19.8 +/- 8.7% vs. 10.7 +/- 6.3% p <0.001) and WEA (14.2 +/- 4.8% vs. 10.6 +/- 5.6% p = 0.02). However, the magnitude of the variability was higher in OA than in WEA (p = 0.02). The visual interpretation of PEF or Oasys-2 failed to distinguish WEA from OA. Conclusion Although workers with OA showed a higher PEF variability than workers with WEA when at work, clinicians were unable to reliably differentiate OA from WEA using the visual interpretation of PEF graphs or the computerized analysis.
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Related Articles Diisocyanate asthma and gene-environment interactions with IL4RA, CD-14, and IL-13 genes. Ann Allergy Asthma Immunol. 2006 Dec;97(6):800-6 Authors: Bernstein DI, Wang N, Campo P, Chakraborty R, Smith A, Cartier A, Boulet LP, Malo JL, Yucesoy B, Luster M, Tarlo SM, Hershey GK BACKGROUND: Diisocyanate asthma (DA) affects 2% to 10% of exposed workers, yet the pathogenetic mechanisms underlying this disorder remain ill defined. OBJECTIVE: To determine if specific single nucleotide polymorphisms (SNPs) of interleukin 4 receptor alpha (IL4RA), IL-13, and CD14 promoter genes are associated with DA. METHODS: Sixty-two workers with DA confirmed by specific inhalation challenge (SIC) and 75 diisocyanate-exposed, SIC-negative workers were analyzed for SNPs associated with IL4RA, IL-13, and CD14 promoter genes. RESULTS: No associations were found with individual SNPs and DA. When stratified according to specific diisocyanate exposure, a significant association was found between IL4RA (I50V) II and DA among individuals exposed to hexamethylene diisocyanate (HDI) (odds ratio [OR], 3.29; 95% confidence interval [CI], 1.33-8.14; P = .01) only. Similarly, the IL4RA (I50V) II and IL-13 (R110Q) RR combination was significantly associated with DA in HDI-exposed workers (OR, 4.13; 95% CI, 1.35-12.68; P = .01), as was the IL4RA (I50V) II and CD14 (C159T) CT genotype combination (OR, 5.2; 95% CI, 1.82-14.88; P = .002) and the triple genotype combination IL4RA (I50V) II, IL-13 (R110Q) RR, and CD14 (C159T) CT (OR, 6.4; 95% CI, 1.57-26.12; P = .01). CONCLUSIONS: Gene-environmental interactions may contribute to the pathogenesis of DA, and gene-gene interactions may modulate this relationship.
Assessment of impairment/disability due to occupational asthma through a multidimensional approach. Eur Respir J. 2006 Dec 20; Authors: Yacoub MR, Lavoie K, Lacoste G, Daigle S, L'archevêque J, Ghezzo H, Lemière C, Malo JL Subjects with occupational asthma (OA) are often left with permanent sequelae after removal from exposure. Assessing impairment/disability should utilize various tools. Aims: Examine whether: 1) assessment of inflammation in induced sputum is relevant to impairment; and 2) use of questionnaires on quality of life and psychological factors can be useful to the evaluation of disability. 40 subjects were prospectively assessed for permanent impairment/disability due to OA two years after cessation of exposure. Impairment was assessed as follows: 1) need for asthma medication; 2) asthma severity; 3) airway calibre and responsiveness; and 4) degree of inflammation in induced sputum. Disability was assessed according to quality of life and psychological distress. There was a significant improvement in airway responsiveness and inflammation from diagnosis to the present assessment. Sputum eosinophils >/=2% and neutrophils > 60% were present in 8 (20%) and 12 (30%) of subjects, one or the other feature being the only abnormalities in 15% of subjects. Quality of life was moderately affected and there was a prevalence close to 50% of depression and anxiety. In the assessment of subjects with OA, information on airway inflammation and psychological impacts are relevant to the assessment of impairment/disability although these findings need further investigation.
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